delegate registration form - organics & millets 2019...

Salutation Surname Forename

Organization

Address

Designation

City Pin code State

Mob Tel Fax

Email Web

CATEGORY

DELEGATE REGISTRATION FORM

PRODUCTS / SERVICES OFFERED (PLEASE MENTION)

ORGANIC STATUS

Certified In Conversion Not Certified PGS/Not Applicable

Exporter

Wholesaler/ Distributor

Farmer’s Group/ FPO

Retail Brand

Retailer

Input Manufacture

Certification Agencies

Hotel and Hospitality

Cosmetic Industry

Medicinal, Aromatic & Dye Plants

Eco- Tourism

Research and Development

Publication House

Health and Wellness

Others (Please Specify)

International Participants

GOVERNMENT OFKARNATAKA

DEPARTMENT OFAGRICULTURE

www.organics-millets.in

NO. OF PERSONS ATTENDING

Particulars

NGO’s

Central/State Govt. O�cer/Scientists

Private Sector

Farmers/ Student

500

1000

1000

200

1000

1500

1500

500

Early Bird o�er(Before 15.12.2018) Spot registration

FOR MORE DETAILS, PLEASE CONTACT

Mr. Jaydip Roy ( Mob: 9901878511 ) or Ms. Anitha ( Mob: 9902745413 )E-mail: jaydip.roy@iccoa.org / events@iccoa.orgICCOA, 294/22, 7th Cross, 1st Block, Jayanagar, Bangalore-560011Tel: 080 26561151 / 26561152First Come First Serve, Limited Stalls.

Charges Per Person

MODE OF PAYMENT

I enclose DD/NEFT to ‘KAPPEC’ payable at Bangalore. DD/RTGS No

Dated for Rs (in words)

drawn on KAPPEC ITF 2019 (bank name) State Bank of India towards payment for Congress Registration.

Bank details: 37848201495 IFSC: SBIN0040374

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